Provider Demographics
NPI:1073807350
Name:CANFIELD, SHANA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:LYNN
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHANA
Other - Middle Name:LYNN
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:831 FULLER AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1901
Mailing Address - Country:US
Mailing Address - Phone:616-458-8063
Mailing Address - Fax:616-458-6711
Practice Address - Street 1:831 FULLER AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1901
Practice Address - Country:US
Practice Address - Phone:616-458-8063
Practice Address - Fax:616-458-6711
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6495002Medicare PIN